! ! COLUMBIA LIBRARIES OFFSITE 

HFAimsr;!! tIM '•'■'AMUAH J 



HX641 47371 
RC736 .W21 Singers' throat trou 




bmg^^ 



Throat Troubles 



yHEiR Cause and Cure 



Course of Lectures delivered at the Grand Conservatory 
of Music, during the season 1883-84. 



BY 



WHITFIELD WARD, A. M. M. D, 

Physician to the Metropolitan Throat Hospital; author of 
" The Throat in Relation to Singing," etc. 






PUBLISHED BY 
THE GRAND CONSERVATORY PUBLISHING CO. 

46 West 23d Street, New York 

lS8q 



:.»?»■* T.v^- -1 r=i - 



\\c i^ ^ 



VJZ\ 



intiitCitpofikttigork 
College of ^fjpsficianfi anb ^urgeonjs 




Hifararp 



Digitized by the Internet Archive 

in 2010 with funding from 

Open Knowledge Commons 



http://www.archive.org/details/singersthroattroOOward 



Singers' 
rhroat Troubles 



"JTheir Cause and Cure 






Course of Lectures delivered at the Grand Conservatory 
of Music, during the season 1883-84. 

BY 

WHITFIELD AVARD, A. M. M. D. 

Physician to the Metropolitan Throat Hospital ; author of 
" The Throat in Relation to Singing," etc. 



PUBLISHED BY 

THE GKAXD CONSERVATORY PUBLISHING CO. 

46 West 23d Street, New York 



\\/A\ 



Copyright by E. Eberhari>, 
1885. 



PRESS OF 

WILLIAM S. GOTTSBERGER, 

11 Murray St., New York. 



PREFACE. 

In this little work which is intended as a companion 
to "The Throcit in Relation to Singing," I have en- 
deavored to present a series of pictures of the most 
prominent ailments peculiar to the vocal organs of 
singers. 

Believing that many voices are annually lost through 
ignorance and mismanagement, 1 have, for the express 
purpose of remedying this evil, undertaken in the fol- 
lowing pages to give the vocalist an insight into many 
of these difficulties. 

THE AUTHOR, 

208 West 25th Street, New York City. 



SlN(;p:kS' IMIKOAT TRD IJ p. Lies 



THEIR CAIISI-: AND CURE. 



CHAl'TKR I. 

The Causes of Throal Troubles iiu<l the Moderu Methods 
of Treatiiieiit. 

IN no other liranch of tlie medical sciences have such rapid strides 
been made within the past decade as in Laryngology, or the diag- 
nosis and treatment of diseases peculiar to tlie upper portion of the 
respiratory tract. Although this science had its beginning in the discovery 
of the principles of examming the throat by Garcia, it is only within a 
few years that the important ailments of the throat have been properly 
studied and the knowledge of these diseases made tliorough and 
comprehensive. 

Now, while the laity possesses a fair idea of the affections of many 
other portions of the human body, it is safe to say that they have very 
little knowledge of the throat, not only regarding its diseases, but also 
concerning its care. 

This is especially noticeable in singers and singing teachers, many 
of the latter class exhibiting the greatest ignorance of ordinary points of 
vocal hygiene. Such ignorance on the part of singing teachers is en- 
tirely inexcusable and is engendered by the false idea that these things 
are Avithout their profession and belong solely to the physician. This is 
a great mistake and productive of much unnecessary sickness. How 
can the master by giving such advice as shall prevent disease trespass 
upon the functions of the physiciaii ? Such an idea is preposterous. 
The vocal trainer by acquainting liimself with the ordinary laws of vocal 
Hygiene, and they certainly are simple enougli, can be the means of 
doing incalculable good to his pupil. Many singers suffer from serious 
throat troubles which could have been easily avoided bv a little good 
advice at the outset of their difficulties. 

The science of laryngology then dating from the adoption of the 
laryngoscope by the medical profession, has gi^own in a comparatively 
short space of time to wonderful proportions. B3- the aid of this truly 



6 SINGERS' THROAT TROUBLES, 

marvelous inslniniout tlie hidtlen recesses of the vocal apparatus are 
brought to light, which enables the seeker after truth to study its internal 
workings. Many wonderful tilings have we learned through the agency 
of the little mirror of the laryngoscope which, when inserted into the 
mouth of the person under examination, gives upon its reflecting surface 
a perfect \iew ol that wonderful little organ the human larynx. 
Aftectiuns which were hitherto unheard of, have been, since the employ- 
ment of the laryngoscopic apparatus, discovered and their nature and 
cause thoroughly investigated. The true science of medicine lies chiefly 
in the diagnosing of disease and not, as is the popular belief, in the art 
of healing. When once an aftection has been successfully diagnosed 
and its cause and peculiarities are thoroughly understood, its cure, pro- 
vided it be a curable complaint, is simple enough. Nature supplying 
the necessary drugs and only requiring a proper selection which, as we 
all know, is based upon experience and experimentation. 

If the laryngoscope has been of service in medical science, it has 
been "none the less valuable in the art of voice-training. Although many 
self-constituted members of the musical profession have from time to 
time ridiculed the laryngoscope and its wonderful i)owcrs, stating that it 
is of no practical value to the singing teacher, yet the fact stands out 
in bold relief, that this instrument is of the utmost worth and imi)ortance 
lo the much abused art of voice training. One gentleman in i)articular 
hailing from that centre of aesthetic art, Boston, took the trouble to 
assail this most valuable instrument, a short time since, in a five-column 
article contributed to a musical journal of this city. 'J'he subject matter 
containeil in the paper referred to above, was of such a nonsensical 
character and disjjlayed such gross ignorance on the part of the writer, 
that, although it was personally aimed at myself, 1 totally ignored it. 
By means of the laryngoscope, an apparatus which consists of three in- 
struments, an illuminator supplying the light, a large mirror strapped to 
the forehead to cast the light into the throat, and a small mirror to in- 
sert into the mouth, we have been enabled to study the mechanism of 
those wonderful little bodies, the vocal cords, which, as we all know, 
are the prime factors in the production of musical tones. If the skeptic, 
be he master or pupil, could see as I have repeatedly, the beautiful 
movements which characterize the mechanical action of the vocal cords 
during vocalization, his skepticism would vanish as a cloud, and he 
would at once become an ardent advocate and admirer of the apparatus 
which enabled him to explore the laryngeal organ. The laryngoscope 
enables us to find defects in the vocal organism which would otherwise 
have remained undiscovered. These defects which are in some cases 
trivial, and in others great, will oftentimes, if neglected, result in a total 
loss o( the vocal powers. The singer is often unaware of any trouble in 
the parts, he simply feels that his vocal abilities are not the same as they 



'I'lll'.ll-; TAIISI': AND CA'RE. j 

were. Now, if i»er( h.iiK.c he li.is a careful .iiid judicifnis master, the 
latter ])er,sonage will at once insist iipoii a laryngeal examination, which, 
if it is undergone, will at once revc.d die difficulty and enable it to be 
remedied in a short time. lUit, if on the <;ontrary, the sufferer has a 
non-believer in l.iryngoscopy for a teacher, this individual will make 
light of his complaints and will assure the jnipil that there is nothing the 
matter with his vocal organs. What will be the result ? Why the voice 
will be more and more impaired and after a varying period of time, 
which depends, of course, on the nature of the defect, the ability of the 
victim to vocalize will be seriously compromised if it. is not entirely 
lost. 

There is almost a universal dread ninong singers of undergoing any 
treatment whatsoever of the throat, consequently many through fear or 
ignorance suffer from and allow to become chronic affections, which if at- 
tended to in time would have required but the simplest and shortest treat- 
ment. The principal effect of this prejudice is the injury of the vocal 
organs which is sure to result and frequently become permanent. I am 
very sorry to say that this dread is fostered among pupils by teachers who 
invariably advise their wards to beware of " Throat doctors " informing 
them that not only, will their vocal apparatus be injured, but that when 
once treatment has been begun they will have to continue it for an 
indefinite period. Such an assertion shows either the grossest ignorance 
or an inordinate love of gain. From my long and varied experience 
with some of these teachers, I am forced to state that in the majority of 
instances ignorance is not the cause of their giving -such advice. How, 
you will immediately ask, can the teacher gain by advising against 
professional treatment of affected vocal organs ? In two ways, when 
the throat is the seat of a slight inflammation, or, in other words, the 
afflicted person has taken cold, the very first thing the physician will 
advise is to stop all singing. Why ? because when the larynx is inflamed 
vocalization only inhances the difticulty. In the treatment of inflam- 
matory diseases, no .matter in what portion of the human economy they 
may be located, the first principal is absolute rest of the parts. This 
precept is especially true of the larynx, because the vocal cords, the 
vibrating reeds producing sound when inflamed are greatly thickened, 
and all acts of vocalization cause a constant rubbing together of these 
important little bodies which, as can be readily seen, will increase the 
inflammatory action, exactly the same effect will be produced, as if an 
inflamed surface on one hand were constantly rubbed by the other, 
namely : A continuance of, and an increase in the diseased condition. 
Now when the physician advises the singer to stop, for the time being 
his studies, he stops the flow of ducats into the pockets of the unscru- 
pulous teacher. Of course it is only when the inflammation is slight 
that the foregoing remarks are applicable. When the inflammatorj' 



8 SINGERS" TITROA r TROURI.ES, 

action is great the singer will he obliged to rest for the simple reason 
that the congestive swelling of the vocal cords is so great that these 
bodies will be unable to vibrate sufficiently to produce vocal sounds. This 
is indeed a most fortunate thing for the sufferer, and it has been the 
means of preserving many voices. When the inflammatory action is 
slight, and the resultant hoarseness or huskiness corresjjondingly so, 
then it is that the bad advice of a bad teacher will be productive of 
considerable harm. I have been repeatedly told by singers, that their 
teachers have advised them to sing off their colds, that although the voice 
was hoarse exercise would remove the diflicully. In some instances it 
will do this, but only for tlie time being, and at the expense of the 
sufterer's voice. Why ? because it will call into play the large external 
laryngeal muscles, bodies that ordinarily have nothing to do with vocal- 
ization, and whose action will in time be productive of the greatest 
injury to the voice. The second answer to the question given above, is 
that many masters are afraid to let an expert see the result of their labor. 
The experienced examiner can, with the aid of tiie laryngoscope, tell in 
an instant whether the voice has been properly trained or not. This 
may seem a' broad statement but it is true in every respect. When the 
voice has been properly trained the vocal cords present a beautiful 
appearance not only as regards color and conformity, but also as 
regards their physiological action. Their color is a pearly white and 
when approximated or adducted, they present the appearance of two 
firm bands of tissue seperated by a fine and somewhat symmetrical 
opening. This interval is known as the chink of the glottis, and is 
always present during ortlinary acts of vocalization. The function of 
tlie chink of the glottis is to provide a passage for the exit of air wliich 
is a prime foctor in the production of sound, ^^'hen, however, the 
vocalist has been the victim of bad training, the vocal cords instead of 
presenting the above appearance are flabby and relaxed and more or 
less thickened and congested. The chink of the glottis is also partially 
or totally obliterated while the entire larynx is somewhat relaxed and fre- 
quently congested. What does all this show ? simply that the methods 
of teaching employed have been faulty. A relaxed condition of the 
vocal cords is the condition most often resulting from improper tuition. 
No pair of vocal cords can perform their duty properly unless they 
possess a certain degree of firmness. U they are in any manner 
relaxed it will be impossible for the delicate vocal muscles to tense 
them to such a degree as to produce a tone properly. How then can 
a vocalist with such a jiair of cords sing ? By bringing to bear on the 
cords the large external laryngeal muscles, bodies which ordinarily have 
nothing to do with vocalization; or in plainer language by forcing the 
voice. Such action will most certainly be followed by loss of voice. I 
have seen this result too often to admit of any doubt. 



'Illl'-.IR CAUSK AND r:(JkF,. ^ 

I have often wai"ii(,'(l sliidciils .■i}j,.iiiisl lliosr vvlif;iii I know have 
h;irnie(l lh(;ir voices. In doinj^ this I siniply iierforni my duty. J have 
no esi)ecial favorites ;nnong teaeliers but when 1 see a larynx whirh has 
been developed by a good and careful trniner I am only too willing to 
applaud his work. 

Very many voc.il mristcrs nn; wont to defend themselves by assert- 
ing that the injuiy to their pupils voices was accomplished by some 
former instructor. y\ll I can say in answer to this is that if the master 
after a certain periotl of time, finds that there is some physical obstacle 
to the proper training of a puijil's voice, he should advise him to have 
the vocal apparatus tlu^rouglTly examined with the laryngescope by an 
expert, and be guided by the examiner's diagnosis. If the teacher does 
not do this, but, on tlie contrary, continues his endeavors to train such 
a case, he renders himself partially culpable for his pupil's condition 
because his tuition increases the difficulty. It is a golden rule, and it 
should always be in the mind of the vocal-master, that unless the entire 
vocal apparatus is in a proper condition it will be absolutely impossible 
for the scholar to receive any good whatsoever from his instruction no 
matter how perfect may be the method employed. The affections of 
the throat met with in medical practice are not dissimilar from the 
diseases encountered in other regions of the body. 

Inflammation occurs in its various grades, we likewise have the 
products of inflammation, such as swellings and tumors of various kinds 
and finally we meet with many nervous ailments. The mucus mem- 
brane with which the entire respiratory tract is lined is with but few 
exceptions the seat of throat disease. The reason of this peculiar pro- 
clivity is partly from the exposed position of the membrane hning the 
throat, aqd partly from extension of diseases existing in adjacent parts 
which in this portion of the body, are peculiarly prone to spread! 

Most of the mflammatory affections of the throat commence in the 
pharynx or back wall of the throat, though not infrequently they begin 
in the nasal passages. The affection of the nose which is more apt to 
spread is nasal catavrli. The acute form of this disease will often times 
affect the larynx in a few days, while the chronic form will generally 
take a number of months. These phenomena are more often observed 
in singers afflicted with nasal catarrh, especially if the disease be local- 
ized in the large cavities of the back of the nose. I have so often 
seen the above result that I can almost guarantee it unless perchance 
the afflicted individual attend to the malady in time. The laryngeal 
affection thus produced is of a catarrhal nature and is especially marked 
in those wonderful little bodies the vocal cords and tissues in their 
immediate vicinity. The reason for the appearance of catarrh in the 
larynx as a secondary disease among singers is no doubt due to the 
constant use of the vocal bodies during vocalatory action. The causes 



10 STNGERS' THROAT TROUBLES, 

for llie development of ihroat diseases may be arranged under two 
headings, namely : Predisposing and exciting. 

PREDISPOSING CAUSES. 

By the term predisposing, we mean any cause, either in the system 
at large or in the immediate vicinity of the throat wliich renders the 
person more liable to the incejition of these diseases. 

The princijjal of the jtredisposing causes are four in number, 
namely : 

OVKRWORK. EITHER BODILY OR MENrAi,LY. 

EXTREME SENSITIVENESS OE THE MUCOUS MEM- 
BRANE LININC; THE 'THROAT. 

HERIDITARY CONSTITUTIONAL DISEASES, AS SCRO- 
EULA, SYPHILIS, ETC., AND 

• , PREVIOUS THROA'T TROUBLES WHICH HAVE NOT 
BEEN THOROUGHLY CURED. 

When the constitution has been run down by overwork, the body 
is rendered peculiarly susceptible to the taking of disease. 

In order that the syst(?m shall ward oft' the many affections which 
are constantly striving to prey upon it, it must be in a perfectly strong 
condition. \V hen the system is weakened, the blood becomes more or 
less stagnant in the blood-vessels, which are found in great numbers on 
the surface of the body. The blocking up of the circulatory system, of 
course greatly interferes with its function, the distribution of the blood 
into every nook and corner of the body, and hence, in itself, is a cause 
of disease. With reference to the production of throat aftections, the 
interference in the circulation of the blood, as above described, is mani- 
fested in the mucous membrane lining the several cavities located at the 
upper portion of the respiratory tract. Insufficient nourishment will 
also invariably place the body in a fitting condition for the reception of 
disease. 

The vast army of sewing girls, who are alike overworked and un- 
derfed, furnish ample illustration of this cause. 

Some individuals are endowed with peculiarly .sensitive throats; it 
makes no difference how great care they take of themselves they are 
always " catching cold." In many instances this excessive sensibility is 
unavoidable but, on the contrary, in many other cases it is developed 
and maintained by the peculiar habits of the afflicted parties. Many 
individuals take altogether too great care of themselves ; they accustom 
themselves to overheated apartments, seldom if ever venturing out of 
doors when the weather is at all inclement. If perchance these hot- 
house plants are compelled to venture out, they are so wrapped up as to 



Tlliak CAIISK ANI) rilKK. I I 

he ll^l|■e(■.()g1liz;^l)lc^ Wli;il will lie l.lic icsiill, (jfsiK.li ,i course? Why, il, 
will produce such ,iii .iinouiit of delicacy and sensitiveness in the persons 
practicing it, that. th(;y ( .1111101. fail to take cold nt the slightest exposure, 
it is astonishing whal a trivial cause will produc-.c a most serious cold in 
this class of individuals; simply standing by an open window for a few 
seconds, or sitting by a door slightly ajar, or a slight fall of ternijcrature 
in the sleeping apartment during the night being oftentimes sufficient. 
Now, while 1 do not advocate uimecessary exposure, I should advise 
everybody to accustom themselves as far as practicable to the different 
climatic changes so characteristic of this portion of the globe. As re- 
gards clothing, the body should at all limes be comfortably clad. The 
habit of bundling, more especially in the neighborhood of the throat, is 
a pernicious one and is, in itself, a prime cause of throat ailments. 
Frequently from neglect or bad treatment inflamatory affections of the 
throat which, had they been pro])erly attended to at the time, would 
have been speedily cured, remain in a subdued or chronic form for an 
indefinite period. vMthough in many of these cases, the amount of 
inflammation remaining in the parts is very slight, yet it is sufficient to 
provide a nucleus for quite a severe throat trouble at the slightest cause. 
This well-known fact accounts for the many repeated attacks of sore 
throat with which some individuals are so constantly afflicted. 1 have 
seen and treated very many such cases, and I have repeatedly demon- 
strated the fact that when the throats of these persons are restored to 
their normal healthy condition, they are not more ])rone to these 
affections than their fellow beings. 

Such heriditary affections as consumption, scrofula, syphilis, etc., 
render the afflicted party more liable to inflammatory diseases on ac- 
count of the alteration in the constituents of the blood which these heir- 
looms produce. Some of the worst forms of throat aftections which the 
specialist is called upon to treat are superinduced by the above causes. 

EXCITING CAUSES. 

By the term exciting we mean any cause whether climatic or other- 
wise which by its direct effect produces inflammatory action. 
Among the most frequent of the exciting causes are : 

THE DIRECT ACTION OF COLD. 

THE INHALATION OF SOLID OR FLUID PARTICLES 
EXISTING IN THE ATMOSPHERE. 

THE INHALATION OF TOBACCO SMOKE, AND THE 
PROMISCUOUS USE OF HOT AND COLD FOOD. 

The manner in which exposure to cold produces inflammator\ 
action is peculiarly interesting. The entire surface of the body is covered 



12 StNGfiRS' THROAT TROUBLES, 

with an immense quantity of little glands which secret a fluid whose 
function is to keep the body in a moist condition. The tluid secreted in 
these minute glands which, as we all know, is perspiration, is jioured 
out upon the body through an immense number of little lubes called the 
sweat pores. Now, if the body is subjected to an unusual amount of 
cold, all these little pores through which the perspiratory fluid oozes are 
instantly close, which in turn will cause an instantaneous checking of 
perspiration. When the cutaneous secretion is checked in the above 
manner, or any portion of the human frame, all the blood is driven from 
the surface to the organ or organs immediately subjacent, which causes 
them to be supplied with a greater amount of blood than is necessary 
producing congestion the precursor of inflammation. If this checking 
of perspiration occurs in the chest, the trouble is manifested in the 
lungs — producing that most prevalent and fatal disease, pneumonia. If 
the sudden closure of the sweat-pores takes place in the lower portion of 
the back, kidney affections are apt to supervene, and finally, if the inter- 
ference to the flow of the perspiratory fluid takes place in the throat, 
laryngeal ailments are the result. 

The reasons why the larynx and other organs in its immediate 
vicinity are so frequently attacked by cold are two-fold. Firsts their 
close proximity to the external surface of the body, and second, because 
they are located in that portion of the frame which is generally 
unclothed. 

The first effect of the action of cold upon the mucous membrane 
lining the vocal organs is a checking of the natural secretion of the 
parts. This accounts for the dry and parclied sensation which is expe- 
rienced in the mouth, and is so characteristic of the early stages of 
inflammatory affections in this cavity. The next effect is a more or less 
copious expectoration of a viscid and whitish-colored mucus. The 
latter symptom is manifested from twenty-four to forty-eight hours after 
the reception of the cold — that is when the inflammation has become 
more prominent. The inhalation of solid or fluid particles existing in 
the atmosphere under certain conditions, is also a most frequent exciting 
cause of throat difliculties. 

These particles act either mechanically or chemically upon the 
structures with which they come in contact ; mechanically by producing 
irritation, which is the first step in the inflammatory process, and chem- 
ically by altering the nature of the parts they come m contact with. 

Artizans exposed to the dust of various workshops, attendants in 
chemical laboratories and others similarly imperiled are most apt to 
suffer in this way. Inhalation of the dust of the streets, which as we all 
know contains many noxious and irritating ingredients particularly in 
windy weather, is also productive of many vocal ailments. The inhala- 
tion of tobacco smoke is also a prime cause of throat affections. It is 



'I'llKIK CAUSE AND CURK. l-j 

not necessary for tiic siiflcrer to be a smoker himself, the mere fact of 
his being confined for lioiirs in an atmosphere charged with the fumes of 
tobacco is frequently sufficient to produce these troubles. 'J'he above 
statement may seem a little too strong to the uninformed, but I have 
met M^ith many cases of throat diseases which have been brought about 
in this manner during my long experience as a throat specialist. It is 
hardly necessary for me to add that the direct indulgence in the weed 
will oftentimes produce these ailments. In this instance they are caused 
by the constant irritation of the smoke, which in turn produces a dryness 
of the parts. The affections thus engendered are generally of a chronic 
or long-standing nature. l"he promiscuous use of hot and cold food 
and drink at the same meal is an apparent cause of throat difficulties. 
Thus we partake of hot soup, or drink hot coffee or tea, and cool the 
mouth by draughts of ice-water taken at intervals during the meal ; or 
after enjoying a warm dinner, we indulge in ice cream or water-ice, and 
follow this by a draught of hot coffee. This alternate application of hot 
and cold to the delicate mucous membrane of the throat can hardly fail 
if persisted in at least to place it in a condition favorable for the inflama- 
tory process. 

Prior to the invention of the laryngoscope the diseases peculiar to 
the vocal organs received little if any attention. Physicians in general 
were, apt to content themselves with prescribing some internal remedy, 
coupled with a gargle or some disagreeable external appHcation. Some 
members of the medical profession, ignoring laryngeal affections alto- 
gether, were wont to ascribe their patients' symptoms to nervousness, 
billiousness, etc. Consequently the sufferer received very little sympathy 
and certainly no proper medication. Those, forsooth, who at that time 
undertook to treat the throat, did so in such a harsh and bungling 
manner that to make use of a common saying, " the cure was worse 
than the disease." A favorite method of treatment in the prelaryngo- 
scopic period, was the introduction into the mouth of a sponge satur- 
ated with some strong caustic solution,' as for instance, nitrate of silver, or 
nitric acid. This plan of medication not only occasioned great pain to the 
patient, but in ninty-nine cases out of a hundred aggravated the disease. 

Another favorite remedy in throat affections during the period above 
alluded to, was the depletion of the body by blood-letting, or venesec- 
tion as it is technically called. It was thought at that time, by those 
who employed this latter plan of treatment, that if the amount of blood 
was lessened in the parts inflammatory action would be reduced. 
Another popular method of treatment then employed was salivation, 
that is the internal administration of mercury in such quantities as to 
produce inflammation of the mouth, especially in the neighborhood of 
the gums. In some cases salivation was carried to such an extent as to 
produce a loosening and a dropping out of the teeth, 



14 



SINGERS' THROAT TROUBLES, 



Now, however, all things are < lianged, the treatment of diseases of 
the throat having been brought to such a state of perfection that it 
seems to .me to be almost impossible to improve upon it. What has 
brought about this metamorphosis? Why, the laryngoscope, which by 
its wonderful powers have enabled us to study and understand the 
affections peculiar to the upper portion of the respiratory tract. 

The treatment of the throat and neighboring parts, as employed at 
the present time consist mainly in the application of medicines directly 
to the diseased tissues. These applications are made through the 
agency of instruments especially designed for this i)ur])Ose. No matter 
where the disease may be located whether in the remotest portion of the 
throat or nose it can be easily reached and the medicines thoroughly 
applied thereto. 

Very many throat troubles which have resisted other methods of 
treatment for months, are oftentimes entirely cured by a few applications 
of drugs made in the [)roper manner. 

The principal methods of treating the throat are three in number, 
namely : 

THE MEDICATED SPRAY 

BRUSH APPLICATIONS AND 

INSUFFLATION 

The medicated spray consists simply in the application of drugs in 
the form of a fine ^ spray into the diseased organs. The appliance 
made use of in tlie manufacture of these sprays is a peculiar one, and 
consists essentially of three instruments, an ordinary force pump, a 
copper boiler, and a set of glass tubes called spray-producers. Air is 
forced into the boiler by means of the force pump to which it is attached 
by an ordinary piece of rubber tubing. When sufficient air has been 
pumped into the boiler it is allowed to issue therefrom through a second 
piece of rubber tubing which is attached to 'the spray-producer. The 
spray-producer which resembles somewhat an ordinary cologne atomi- 
zer is inserted into a bottle containing the medicine to be used which, 
when the compressed air traverses the tub6 issues in the form of a very 
fine and powerful spray. 

THE BRUSH TREATMENT consists simply in the introduc- 
tion of small camels' hair bruslies, saturated with some medicated solu- 
tion into the diseased organ itself. 

INSUFFLATION consists simply in the blowing of medicated 
powders into the affected parts. This operation is best performed 
through the agency of the apparatus above described in connection 
with the medicated spray. The tubes, however, although resembling 
somewhat the spray-producers are constructed on a different principle, 
since they are intended to transmit powders instead of liquids. 



THETR CATTSE AND riTKK. 



T5 



Of the several forms of trc'ilnn'iil, dclincaled above, the medicaterl 
spray is by far the most useful in I he majority of throat ailments. For 
the treatment of that most prevalent of all diseases, nasal catarrh, this 
method is of the utmost worth, its employment being absolutely neces- 
sary to a cure of the disease. 

In no other branch of medical sf:i'n<cs has '[nackery obtained such 
a firm footing as in the diseases of I lie iliroai and nasal organs. This 
state of affairs is not only due to the great prevalence of these affections 
in this climate, but also to the disposition of many individuals to exhaust 
every resource before applying to the skilled physician for relief. What 
is the result of this course ? AVhy, very many troubles which could 
have been cured by a few applications and at a trivial expense if the 
patient had applied for treatment in time will oftentimes necessitate a 
long course of medication for their relief. 'I'his fact is especially true 
with reference to nasal catarrh for the cure of which disease, an in- 
numerable number of instruments and infallible remedies have been 
from time to time invented and discovered. 

These contrivances, if they are sufficiently well advertised are sold 
by the score and fill the pockets of the unscrupulous dealers. While 
many of the so-called cures aje harmless in their action, there are many 
others positively injurious oftentimes destroying the delicate mucous 
membrane lining the upper portion of the respiratory tract. 

I have many times seen extensive ulceration of the nose caused by 
the snuffing through the nostrils of powders guaranteed to cure this 
most distressing affection. 



CHAPTER IT. 



NASAL CATARRH. 



The diseases which are encountered within the throat and its im- 
mediate vicinity are exceedingly interesting, not onh'^ on account of 
their great frequency, but also from the evil effects produced by them 
upon the entire vocal apparatus. In the present discourse it will of 
course, be impossible for me to give a thorough exposition of the many 
ailments so frequently met with in this portion of the bod}'. I have 
therefore endeavored to select those which on account of their prevalence 
among singers, shall be most interesting to this class of individuals. 



'l6 SINGERS' THROAT TROUBLES. 

The affections which I sliall describe in the following pages are 
four in number, namely : 

NASAL CATARRH. 

PHARYNGiriS OR ORDINARY SORK THROAT. 
LARYNGITIS and 

PARALYSIS OF THK VOCAL CORDS. 

The most prevalent by far of all the diseases found in the upper 
portion of the respiratory tract is nasal catarrh. 

To no class of individuals does this affection occasion so much suffer- 
ing and annoyance as to the singer who is in constant use of his vocal 
organs, since many vocal sounds are entirely dependent upon the 
healthy condition of the mucous membrane lining the nasal cavities. 

Every cavity of the human body is lined with a soft and pliable 
membrane styled mucous membrane. It is called mucous because it 
secrets a fluid of more or le.ss pasty consistency, the office of which is 
to keep the parts moist. I especially desire that this fact shall be well 
born in mind, because it applies equally well with reference to the 
mouth and the laryngeal cavity. The disease under consideration is 
simply a chronic or long standing infla4nmation of the nasal mucous 
membrane characterized by a more or less copious discharge of diseased 
mucous from the parts. 

In well marked cases of this disease the membrane referred to above 
is often found to be the seat of large ulcers, brought about by the decay 
of the soft tissues of the nasal organ. 

The symptonts of nasal catarrh are many and varied, the most 
prominent of which are : 

OBSTRUCTION OF THF NASAL PASSAGES. 

A COPIOUS DISCHARGE OF MUCOUS. 

PAIN OF A DULL AND HEAVY CHARACTER AND 

IMPAIRMENT OF THE SENSE OF SMELL. 

The obstruction of the nasal passages is due to a swelling or thick- 
ening of the membranous lining. In some severe cases of catarrh the 
nostrils are entirely occluded, consec[uently respiration through the 
nasal canals is completely shut off. This obstruction is usually greater 
in damp than in dry weather, and not infrequently we find that either 
one passage or the other is nearly wholly impervious to the air, there 
being no regularity with respect to the nostril affected. The constant 
discharge of fetid mucous is undoubtedly the most disagreeable feature 
of nasal catarrh since it compels the sufferer to make constant endeavors 
to discharge it. When the large cavity at the back of the nose, known 
as the post-nasal cavity is affected, there is a constant dropping of 



TIIKIR CAUSP: and CdRK. 



>7 



mucous into llic Ijuck of I lie luoulii. VVIkmi tliu sufferer from nasal 
catarri) is unable to expcll I Ik- mm oiis which is being constantly pourerl 
forth from the deceased mcuihranc, the ravities of the nose, after a short 
time become completely blocked n|i. There arc two reasons for this 
accumulation. 

FIRST, The mucous hcinL; thick and tenacious becomes firmly 
attached, or, as it were, joined to the parts, and is therefore capable of 
resisting all ordinary efforts of expulsion. 

SECOND, The niucous membrane being diseased is unable to 
perform its natural function, namely, the expulsion of the secretion 
accumulating on its surface. 

Pain as a general thing is not a prominent sympton of this affection. 
In some cases, however, it is well marked and the occasion of a great 
deal of worriment. Its most frequent seat is generally immediately 
beneath the eyes at the most depressed portion of the nose. 

Deafness and impairments of the sense of smell oftentimes result 
from neglected cases of nasal catarrh. The first manifestation is due to 
the extension of the disease through the ear ducts into the cavity of the 
ear itself, while the second is owing to the deadening of the nasal 
mucous membrane. 

Nasal catarrh in a vast number of cases is caused by frequent 
and repeated attacks of " cold in the head." Quite frequently the 
disease commences in a slow and insidious manner, and is present in the 
parts several months before the sufferer is conscious of its existence. 

The influence of this disease upon the singing voice is at all times 
most marked, and may be either immediate or remote. The immediate 
effect of an attack of catarrhal inflammation will be the utter impossi- 
bility of rendering certain portions of the vocal register. 

The tones most affected will be those which in their journey from 
the body issue solely from tlie nasal cavities. Those tones which issue 
partly from the nose and partly from the mouth will, of a necessitv, be 
only partially affected by the above state of affairs. This interference 
to vocal sounds is due to the thickening of the mucous membrane lining 
the nasal canals. 

In order that the thickening of the mucous membrane characteriz- 
ing nasal catarrh be removed, it is necessary to undergo a series of 
treatments by the skilled physician which consists simply in the thorough 
and repeated applications of medicines to the diseased parts. The 
remote effect of nasal catarrh upon the voice is of the most pronounced 
character. When the vocalist thus affected begins to find out that 
certain tones are being poorly rendered, unless he thoroughly under- 
stands the cause, he is apt to strain every nerve to regain his lost power. 
By so doing he brings more force to bear upon those delicate bands, 
the vocal cords. For a time this metliod of singing improves the tones. 



i8 SINGERS' THROAT TROUBLES, 

but at a heavy price, namely, injury to the vocal cords. Why ? Because 
the extra forces invoked are the stronger muscles outside the larynx — 
bodies which ordinarily have nothing to do with singing. What does 
this method of vocalization lead to ? Strain of the voice which is 
greater or less according to the amount of nasal obstruction, and the 
length of time the extra forces are employed. 'I'his result I have seen 
very many times, in fact, scarcely a day. passes but that a singer consults 
me who has been endeavoring to render tones whicii could not be made 
properly on account of obstructions existing in the nasal passages, the 
direct cause of catarrhal swelling. 

Aside from its effect upon the vocal apparatus nasal catarrh is pro- 
ductive of much harm, and is a direct cause of many other throat com- 
plaints. Why ? Because to a greater or less extent it compels the 
afflicted person to breathe through the mouth. The nose is the only 
channel through which air should pass into the bo'ly during ordinary 
acts of breathing, the mouth being intended only as an accessory 
breathing agent when on certain occasions — as for instance running — 
the lungs demand a rapid and increased supply of air. 

The air in passing through the nostrils is warmed and sifted of its 
harmful ingredients and thus prepared for its reception into the delicate 
structures below. If it goes directly into the mouth without the above 
preparation, it will frequently cause irritation and inflammation of the 
mucous membrane lining of the mouth and throat by being, in the first 
place too cold, and in the second place, by containing irritating particles 
of dust and other matter. 

We will now pass on to a consideration of that part of this subject 
which the singer, in all probability, will consider of the most importance, 
namely, can nasal catarrh be cured ? My answer to this query is, cer- 
tainly if the proper treatment be employed in the proper manner. The 
inquiring mind will immediately ask, why then do so many people, and 
among them many physicians, constantly assert that this affection is 
incurable ? Simply because they have not properly investigated the 
subject. You must remember that the science of laryngology is still in 
its infancy, and that but a few years ago little or nothing was known 
concerning the cause and treatment of the many ailments peculiar to the 
throat, in fact, not until the discovery of the beautiful instruments by 
which we are enabled to see the hidden recesses of the throat and nose. 
Since the employment of this apparatus, diseases, which were hitherto 
not at all understood, have been investigated and their cause thoroughly 
made out. To none of these affections do the foregoing remarks apply 
more forcibly than to nasal catarrh, concerning the cure of which science 
has done so much during the past decade. 

The treatment of this most distressing affection must be of the 
mo.st thorough nature. 



Til KIR CAUSK AND CIJKK. 



'9 



Iwery portion ollhc nas.il ihikoii^ incinbranc must be treated with 
the proper apphcations and no pari, no matter how remote, must 1;e 
allowed to go untouched. The necessary applications are made through 
the agency of a special set of instruments which are mani[)ulatcd under 
the brilliant light of the laryngoscope. 

The most important and useful of the instruments u.sed for this 
purpose is the compressed air apparatus. Viy means of this contrivance a 
most powerful liquid spray can be forced into the nasal cavities both in 
front and behind and the medicines thoroughly applied thereby. Of 
late years owing no doubt to the great prevalence of nasal catarrh, very 
many quack nostrums and patented appliances have been extensively 
advertised as specifics for the cure of this disagreeable affection. Each 
one of the above are always accompanied by an unlimited number of 
signed certificates which testify as to the inestimable value of the article 
in question and are thus calculated to attract the eye and the pocket of 
the unwary victim. 1 could, were I so disposed, fill a book with narra- 
tives concerning the effect of many of these articles upon the delicate 
mucous membrane lining the nose, but I shall content myself with the 
statement that the best of them are only palliative and not in any man- 
ner curative while the remainder are extremely injurious. Many of the 
nostrums contain ingredients the employment of which will not only 
increase the inflammatory action, but will also if persevered 'in, excite 
ulceration in the delicate nasal membranes. It stands to reason that no 
remedy, no matter how meritorious it may be, can effect a cure in a 
number of cases, since there are very many forms of nasal catarrh, and 
in order to differentiate between them it is necessary that a thorough 
examination be made by a skilled physician. Generally speaking that 
drug which may be most serviceable in one case may be extremely 
harmful in another. This assertion is not true only in the nasal organs 
but holds good with reference to ailments located in any other portion of 
the body. Some persons spend more money, and to no purpose, on 
quacks than the legitimate cure of their affection would cost in the 
hands of the regular physician. It is only necessary in this age of pro- 
gress for the quack to prepare some nostrum, no matter how worthless 
it may be, and proi)erly advertise it, and he is certain to reap a rich 
harvest gleaned tVom the pockets of the gullable public. 



CHAPTER III. 

PHARYNGITIS. 

Phariiygilis or ordinary sore throat is simply an inflammation of 
the mucous membrane lining the pharynx or l)ack wall of the cavity of 



20 SINGERS' THROAT TROUBLES, 

the mouth. This disease may present itself in two forms, namely an 
acute and a chronic. In the ACUTE or recent form of inllammation 
the affected tissues are found, upon laryngeal examination, to be greatly 
swollen and congested the mucous membrane lining the parts presenting 
a deep red color. The sensations experience by the j^atient are 
peculiar, and characteristic of the disease. The principal symjjtoms are 
pain in swallowing, dryness of the mouth a harsh and rasping cough, 
and later on in the attack, a copious expectoration of frothy mucous. 
The most frequent cause of this form of throat trouble is exposure to 
cold when the body is unprepared to withstand it. Although very many 
cases of this disease are produced by the carelessness of the affected 
persons many more are caused by some unforeseen and unavoidable 
circumstance. Very many persons take cold in passing from a heated 
theatre or concert hall to the cooler street beyond. No matter how 
high the temperature may be outside it is generally from ten to twenty- 
five degrees warmer inside, hence the sudden transition will oftentimes 
produce quite a serious attack of sore throat unless, forsooth, the exposed 
party be provided with extra garments. In the chronic or long-stand- 
ing form of sore throat the affected tissues are not nearly as red or con- 
gested as in the acute form, the symptoms, however, experienced by the 
patient are more numerous and more cleasly defined. 

There is apt to be more or less difficulty in swallowing, the mucous 
membrane lining this portion of the throat being thickened and covered 
with a thick and pasty mucous. There is always present a sharp dry 
cough which is caused by the efforts of the patient to expel the mucous. 
There is also apt to be present a peculiar feeling as if the parts were 
covered with some foreign substance. The effect upon the voice of a 
chronic sore throat is sometimes quite marked. When the inflammation 
is great and there is much swelling of the tissues, there is a certain 
amount of huskiness and thickening of the voice with also a lack 'of 
vocal control and a tendency to tire easily. Among the causes for this 
disagreeable affection, there are two which deserve special consideration, 
namely : 

THE IMMODERATE USE OF TOBACCO, AND THE ABUSE 
OF ALCOHOLIC LIQUORS. 

It is an undisputed fact that the smoke arising from tobacco is an 
irritant to the delicate mucous membrane lining the air passages. This 
effect is more especially noticeable in persons afflicted with delicate 
throats. It has been asserted as an argument in favor of the use of 
tobacco, " That the mucous membrane of the throat becomes, after the 
lapse of a certain period of time, hardened and inured." This is merely 
a possible result and should not induce the singer, especially if he have 
any throat trouble, to persevere in the use of tobacco. The vocalist 



THEIR CAUSE AND CURE. 



21 



who wishes to preserve liis voice sliouUl not smoke, Init if lie must use 
the weed, let him remember that smoking immediately after singing 
is harmful, because the vocal organs are then in a congested state and 
easily acted upon by any irritant. 

There is another fact with relation to this subject and which should 
always be born in mind I)y those indulging in the excessive use of 
tobacco, and tliat is that the constant absorption of nicotine, which, as 
we all know, is deadly poison, is not only injurious to the system at 
large, but also to the delicate tissues of the mouth. I cannot too 
forcibly impress it upon the mind of the singer, if he wishes to retain his 
voice in its natural purity, to abstain entirely from the use of tobacco, 
even though for the time being it may seemingly produce no ill effect. 

If the employment of tobacco is harmful to the vocal organs the 
use of alcoholic stimulants is ten-fold more so. 

Alcohol is an irritant to all mucous membranes, especially to that 
lining the air passages, and if used to any extent will assuredly in time 
create inflammatory action in these parts. If the drinking habits are 
persevered in sufficiendy long permanent injury will undoubtedly be 
done to the vocal apparatus. 

Some artists, prompted no doubt by bad advice, are in the habit of 
imbibing alcoholic stimulants immediately previous to vocalizing. I 
wish particularly to warn singers against this pernicious habit which, if 
persisted in, cannot fail to be productive of serious consequences. 

The treatment of the two forms of sore throat depicted above must 
be chiefly of a local nature ; that is to say the medicines employed must 
be applied direcriy upon the diseased surfaces. The most valuable 
agent in the treatment of these ailments is the compressed air apparatus 
already incidentally alluded to. By means of this appliance the medi- 
cated solutions can be thoroughly distributed over the diseased tissues 
in the form ot a fine and powerful spray. 

Camel's hair brushes attached to a long and slender handle can 
also be often used to advantage in making applications in this species of 
throat trouble, but their employment, except in some special cases, is 
neither as agreeable nor as efiicacious as the compressed air spray. The 
other forms of treatment generally employed in this class of diseases are 
gargles and medicated troches. These agents are in no manner cura- 
tive, they are simply pallative. They are beneficial in two ways, namely : 
By keeping the parts free from mucous and by soothing the inflamed 
tissues. 



22 SINGERS' THROAT TROUBLES, 

C H A FT K K 1 \ . 

LARYNc;rris. 

Laryngitis is an inflammation of the mucous membrane lining the 
larynx or voice-box. It presents itself like the affection just considered, 
in two forms, namely : An acute and a chronic. The acute or recent 
form is generally superinduced by exposure to cold or rapid changes of 
temperature. Upon inspection of the parts with the valuable assistance of 
the laryngoscope, the larynx presents a characteristic appearance, being 
very red and swollen, a direct eftect ol' the inflammatory process. These 
manifestations are generally most noticeable in the vocal cords the 
sound-producing reeds of the voice-box. these bands, being very highly 
colored, thus offering quite a contrast to their natural appearance, 
namely : A pearly wliite. Tlie most prominent symptom, however, is 
impairment of the voice both in talking and singmg. The talking voice 
is husky or hoarse in direct proportion to the severity of the attack. 
When the voice is thus affected talking in a loud tone, even for a short 
lime, will invariable increase the hoarseness. The singing voice is 
always greatly affected; proper vocahzation being out of the question. 
The reason why the voice is affected by this form of laryngitis is easily 
demonstrated. The vocal cords, in order to perform their function 
properly, must be in a healthy condition, tliat is to say they must 
possess their natural i)roportions. When they are the seat of inflamma- 
tory action they become thickened and congested, which not only des- 
troys their vibratory power, but also to a greater or less extent obliter- 
ates the chink of the glottis, the opening between tlie two cords which 
is for the purpose of allowing the air to escape through the laryngeal 
tube. This closure of the chink of the glottis is a prominent cause of 
vocal impairment because the air, which passes through the voice-box 
in a healthy condition, is the motor power which causes the vocal bodies 
to vibrate. Cough is also a prominent symptom and is caused in two 
ways: First, by a constant tickling of the throat, and second, by the 
copious secretion of a thin mucous. The cause of acute laryngitis is, 
like most of the other inflammatory affections of the throat, exposure to 
cold and dampness. 

It is sometimes surprising what a slight exposure will produce this 
affection, the afflicted one being oftentimes totally unaware of having 
exposed himself. The phenomena of taking cold is decidedly interest- 
ing and should in a measure be understood by everybody, especially 
those constantly using their voices. 

When the body is overheated, its surface is covered throughout 
Its entirety with profuse perspiration. Now if wliile in this condition it 



THEIR CAUSE AND CURK. 23 

be subjected to cold, all tlic minute sweat pores whicli abound on its 
surface and through which the perspiratory fluid oozes, will be instantly 
closed, which in turn will cause an instantaneous checking of perspira- 
tion. When the cutaneous secretion is checked in the above manner on 
any portion of the frame, all the blood is driven from the surface to the 
organ or organs immediately subjacent, which causes them to be sup- 
plied with a much greater amount of sanguinious fluid than is necessary, 
producing congestion, the precursor of inflammation. If the system is 
in prime order it will generally be able to combat successfully this con- 
gestion and prevent its development into inflammation, but if it is weak 
and run down, inflammatory action is a foregone conclusion. The 
reasons why the larynx, and the other organs in its immediate vicinity, 
are so frequently attacked by cold are two-fold : First, they are very 
near the external surface of the body, being covered in lean persons by 
the skin and a few ribbon-like muscles; second, they are situated in that 
part of the frame which is, as a rule; unclothed. 

There is a time when the singer is especially liable to take cold, 
and that is when he proceeds from a warm apartment into the colder 
atmosphere beyond immediately after acts of vocalization. The larynx 
when at work requires a greater amount of blood than during rest, this 
causes it for the time being to be in a congested state, which congestion, 
however, is perfectly natural. When the larynx has accomplished its 
task and is quiescent, the above natural congestion gradually subsides, 
until the vocal organs contain only their^ normal quantity of blood. 
Now, if the vocalist should expose himself to the cold street air before 
this congestion has entirely subsided, he is almost sure to suffer from his 
indiscretionary act. The manner of dressing has a great deal to do 
with the health of the vocalist. The body should be clothed sufficiently 
for warmth and comfort. Too much clothing is as bad as too little 
because it produces an overheating of*the body which in time causes a 
free perspiration, a state of affairs, as we have seen, extremely favorable 
for the reception of a cold. The overbundling of any portion of the 
body, particularly the chest and neck, with wraps, mufflers, &c., renders 
the wearer peculiarly liable to colds because it produces an extra sensi- 
tiveness of the parts. The minute a person thinks he has taken cold 
he piles on chest protectors, extra wraps, &c., not forgetting to encircle 
his neck many times with red flannel. This procedure can do no pos- 
sible good but the greatest amount of harm for the several reasons cited 
above. A very prevalent way of taking cold is the tarrying in over- 
heated apartments with heavy clothing on. This habit is especially 
noticeable among the ladies during their numerous shopping excursions. 
They will remain sometimes an hour or more in a store heated to a 
temperature of from 80° to 100'' without removing their sacks and then, 
while their bodies are bathed in perspiration, proceed immediatelv to 



24 SINGERS' THROAT TROUBLES, 

the cold street beyond. These remarks are especially applicable to 
those wearing seal skin sacks, which have a special tendency to the 
overheating of the body. 

Singers, more especially those iiaving delicate throats, should take 
care to keep the feet warm and dry. Some i)eople are so sensitive that 
a welting of the feet, no matter how slight, will invariably be followed 
by a cold. 

CHRONIC LARYNGITIS. 

This form of laryngitis is an inllaninuition of the mucous membrane 
lining the larynx, of a mild type and chronic character. This, of all 
the laryngeal aftections, is the most prevalent amongst singers. The 
most prominent symptoms are a feeling of tickling or irritation referable 
to the larynx and impairments of the voice either of the singing, or of 
the talking, or of both. There is generally an irritating cough with a 
constant desire to clear the throat. Upon inspecting the parts with the 
laryngoscope, the entire mucous membrane lining the larynx will be seen 
to be congested and considerably thickened in certain localities. The 
vocal cords themselves will be found much thicker than normal and 
reddened instead of being pearly white as in health. The characteristic 
redness is apt to manifest itself in spots or streaks on the vocal bodies. 
A quantity of frothy mucous is nearly always present on the diseased 
tissues. In singers and professional speakers chronic laryngitis is apt to 
be localized in certain portions of the larynx the vocal cords being the 
chief point of attack. There is one condition quite often seen in the 
throats of vocalists affected with this disease, and that is a relaxation or 
giving way of the cords from over-exertion or strain of these bands. 

Chronic laryngitis frequently occurs, as a result of a cold, or more 
properly speaking, a series of colds. Among singers, however, this 
atTection has several special causes, the jirincipal of which are: 

1. Improper training. 

2. Injudicious singing. 

3. False singing. 

4. Strain of the voice. 

4. Other throat affections. 

IMPROPER TRAlxNlNG. 

We cannot over-estimate the evil eflects produced on the delicate 
structures of the larynx by bad training of the voice. I have frequently 
seen a lar\ nx which was perfectly well prior to teaching become utterly 
destroyed in a course of vocal lessons extending over a period of from 
two to three months. One of the chief ways in which chronic inflam- 
mation of the larynx is produced in singers, is the practice in vogue with 
a certain class of teachers, of striving by rapid methods to develop the 



Tt[Krk CAiiSK AND ciJki':. 25 

voice in ;i slioii iiiii<'. 'I'lic (IcvcldiiUMjiii o( Uic voice, as every good 
instructor fully knows, is ;i tedious affair and can only be accomplished 
after years of study. I know that rapid advancement is the tendency of 
the age, and that by developing a voice in a short time the teacher will 
cater not only to the pupil but also to his friends; but still the fact must 
never be lost sight of, lluit by endeavoring to develop the vocal appara- 
tus rapidly, permanent injury is apt to follow. How does over-training 
produce chronic larynx ? By making use of the stronger laryngeal 
muscles, bodies which ordinarily iiave nothing to do with vocalization. 
Why is the aid of these external laryngeal muscles invoked ? Because 
the delicate vocal muscles not having had time to develop sufficiently to 
perform the duties imposed u])on them, outside help is sought. The 
direct effect of the use of these stronger musculnr bodies manifests itself in 
the vocal cords. In the first place, these bodies are congested, that is to 
say a large amount of blood is drawn to the parts by the extra force 
used. The next steji in the process is the production of swelling in the 
parts especially in the neighborhood of the cords and finally after the 
lapse of a varying period of time, which depends upon the exertions of 
the teacher and the susceptibilities of the pupil, this congestion and 
swelling becomes a chronic inflammation and thickening. The mistak- 
ing the register of the pupil will oftentimes produce a chronic laryngitis 
in a manner somewhat similar to that described above. Unskilled 
teachers will frequently attempt to develop a tenor voice from one which 
nature intended to be a baritone or produce a soprano where there are 
only the qualities of a mezzo-soprano. This is also often done by un- 
scrupulous masters in their endeavors to please a certain class of people 
who judge a voice by the height to which its possessor can go. It is in 
the rendition of the higher notes of the register that the efforts of the 
singer will produce the species of inflammation under consideration. 
Why ? Because in the rendition of these notes a greater muscular 
action will have to be brought to bear on the vocal cords because the 
latter bands are not of the proper conformity to produce the desired 
tones with the unaided eftbrts of the delicate vocal muscles. Generally 
speaking the higher the voice the tliinner or finer will be the vocal cords. 
This state of aifairs is to allow of a greater velocity in the vibration of 
these little bands, for the greater the number of vibrations in a specified 
time the higher will be the resulting tone. Now when the cords are 
thicker as in a mezzo-soprano in the female, or a baritone in the male, 
in order to be made thin enough to produce tones that properly belong 
to the soprano or tenor, the cords will have to be stretched more than the 
delicate vocal muscles are able to do, hence the stronger or outside 
laryngeal muscles are made use of, the action of which bodies produce 
the same diseased conditions enumerated with reference to over-training. 
The following case clipped from my note-book will serve as a good 



26 SINGERS' THROAT TROUBLES, 

illustration of this subject. Mr. G , a young gentleman aged about 

twenty, consulted me in January, '82, to ascertain if* possible the reason 
of his inability to sing. Upon laryngeal examination both vocal cords 
were seen to be congested and thickened, and tlie tissues in the imme- 
diate vicinity considerably inflamed. There was likewise visible in the 
larynx a large amount of mucous, which, as I afterwards ascertained, 
occasioned a great deal of annoyance from cough. These symptoms, as 
we have already seen, are those of chronic laryngitis and such was my 
diagnosis. Upon making inquiry, with a view of ascertaing in the cause 
of the trouble I elicted the following facts. About six months prior to 
his consulting me, my patient had placed himself under the tuition of a 
singing master of considerable repute in this city. 

Upon a cursory examination of his pupil's voice, the teacher set 
him down as a tenor and forthwith proceeded to train him as such. 
After the taking of a few lessons, the pupil noticing that it was exceed- 
ingly difficult for him to render certain tones, so informed his teacher, 
who in response told him that it was of no consequence, but that if he 
persevered all would turn out right in the end. My patient being of a 
persevering and enthusiastic nature, kept on in his endeavors, his master 
all the time compelling him to render tones which he was totally inca- 
pable of making without forcing the voice. Matters kept on in this 
wav for a time, the pupil gradually losing his vocal powers, until fortu- 
nately the voice broke down altogether rendering further tuition impos- 
sible. Such was the condition of aftairs when the sufferer applied to me 
for advice. After listening to the above narrative and informing my 
patient as to the cause of his trouble, he placed himself in my hands for 
treatment. 

His disease yielding readily to treatment, I discharged him cured, 
■after the lapse of several weeks, with the strictest injunction not to use 
his vocal organs for at least six months. I did not see the gentleman 
again until the following December, when he called to have his vocal 
apparatus examined to see if everything was all right. Upon a thorough 
examination I found the parts perfectly healtliy in every particular, the 
vocal cords themselves being much stronger than when I last saw him. 
He then informed me that he had begun tuition again in September 
and that his teacher (not the former one) recognizing his voice as that 
of a baritone, was training it as such with very good results. 

INJUDICIOUS SINGING. 

Under this heading a great variety of causes may be arranged as 
producing chronic laryngitis, I shall, however, confine my remarks to 
the most interesting one of all, namely: the exercising of the voice 
when it is husky or hoarse. I think, nay, I am quite certain, that nine- 
tenths of the cases of chronic laryngitis among vocalists are produced 



'IK I'll K CAIJSK AND ( (IRK. 27 

in this manner. When the voice is husky or hoarse il is always a sign 
that tlie vocal cords are more or less congested. Now, as I have 
already stated elsewhere, when these bodies are to any degree inflamed, 
in order that such inflammation shall subside, it is necessary that the 
[)arts be kept quiet. As we all l<iiovv in order to keep the cords still it is 
necessary to refrain from acts of vocalization, since vocal sounds are 
chiefly produced by the direct action of the vocal cords. Sometimes 
the vocalist from a misunderstanding of the cause of the difficulty, and 
sometimes from bad advice, exercises his voice. No efforts of vocaliza- 
tion, no matter how guarded they may be, will ever have a tendency to 
remove laryngeal inflammation, but, on the contrary, will always increase 
it, and if persevered in, will eventually produce a chronic inflammation 
of the parts. Quite frequently vocalists are compelled when under an 
engagement to vocalize during the existence of hoarseness and, sooner 
than compromise their positions, they use their voices when they know 
it will hurt them. One such indiscretionary act may not harm the voice, 
but a persistence in such a course will invariably destroy it. If singers 
will stop for an instant and think of the danger they run in pursuing 
the above plan, they will be more reconciled to a litde temporary 
loss of vocal power, and more willing to give their throats the needed 
rest. 

FALSE SINGING is also another prime cause of chronic laryn- 
gitis. The term false singing is a comprehensive one ; its general 
significance, however, is the employment of false or improper vocal 
methods. '1 he undue employment of the falsetto register may also be 
arranged under this heading. Of the many and bad methods employed 
by poor vocal teachers, that which instructs the pupil to keep his larynx 
fixed during the producting of the many and varied tones so character- 
istic of vocalization, is perhaps the most pernicious. The advocates of 
this peculiar " method" claim that by so doing, not only is the power of 
the voice enhanced, but that its brilHancy is increased. Whether this 
is so or not I am unable to state ; but this I can assuredly state, that 
this "method," so-called, if persevered in for any length of time will, if 
it does not permanently injure the vocal cords, engender faulty habits of 
singing, which will take much time and labor on the part of a good 
teacher to correct. 

In order to hold the larynx in one position during vocalization, the 
large muscles attached to the outside of the organ are brought into 
action, and these bodies acting directly against the vocal muscles, 
impose a much greater force on the vocal bodies than should under any 
circumstances be employed. It is this extra force which does the harm 
and produces the result tabulated above. In the production of the 
falsetto register the vocal cords do not vibrate throughout their entirety, 
as in the singing of a full chest tone, but only in their free edges. 



28 SINGERS' THROAT TROUBLES, 

The cords are. as it were, held in a sort of vice which allows the 
air current, the moter power, to exert an influence only on the edges of 
the vocal bodies. This action on the part of the vocal bands is, to my 
mind, improper and will in time ])roduce a thickening and congestion 
in the voice-box. 

STRAIN OF THE VOICE. 

Strain of the voice is a most frequent cause of chronic laryngitis. 
By straining the voice we mean making it perform work that it is utterly 
incapable of doing properly. 

Whether the harm is done under the guidance of a teacher or 
whether by the unaided efforts of the ])upil, the result is just the same, 
namely: A diseased condition of the Lirynx. The delicate little bands, 
the vocal cords, will not stand any nonsense, hence they rebel when 
treated improperly, a species of congestion being excited which produces 
hoarseness. Now, when this hoarseness is produced, if the singer should 
recognize the cause and remedy it, very little harm would be done; but, 
I am sorry to say, the reverse is generally the case, the straining is per- 
severed in until, what was at first an ordinarj- congestion and swelling, 
has resolved itself into a chronic inflammation and thickening. 

'I'here is a golden rule which, if always observed by singers, would 
preclude the possibility of injury being done to the vocal cords, namely : 
" That all acts of vocalization which are productive of or followed by 
hoarseness, be it ever so slight, are improper and certain to produce a 
chronic inflammation or other injury, if persevered in." 

OTHER THROAT EFFECTIONS. 

Diseases located in other portions of the vocal apparatus are often 
indirectly the cause of chronic laryngitis. 

An ELONGATED UVULA will frequently do this. This little 
organ when diseased is oftentimes so long that it hangs into the cavity 
of the larynx itself and keeps the tissues of this organ in a constant state 
of irritation. This irritation will, after a time, occasion congestion 
which in turn will produce the disease under consideration. If the 
laryngitis thus excited has existed for a short time, the simple operation 
of exercising the Uvula will relieve it; if, however, the inflammation is 
deeper seated, this operation will have to be followed by a course of 
medical treatment. 

ENLARGED TONSILS will also in a measure be productive of 
chronic laryngitis in the singing voice. These glands when enlarged 
ofier quite an obstacle to the proper action of the voice. In order that 
any sort of a tone shall be produced, in persons suffering from enlarge- 
ment of the tonsils, a greater force must be exerted on the vocal bodies, 
which as we have repeatedly seen is productive of laryngeal inflamation. 



THEIR CAlJSI': AND rilRK. 



29 



NASAI/ ( 'ATA l\ k 1 1, cspcci.illy wlicn IIk; ol)Stnir.tif>ns an; inarkf.-d 
in the nasal passages is conductive to the aljove form of laryngeal trouble 
in almost the same manner as enlarged tonsils, that is by offering an 
obstacle to the escape of certain tones, those traversing the nasal canals. 

What will eventually be the result if chronic laryngitis is allowed to 
remain ? Why an entire destruction and breaking uf) of the voice. The 
time for tl)is final giving out of the voice, will df|H.Tid entirely upon the 
manner in which the vocal apparatus is used. If il is treated barlly, a 
few weeks will be sufficient, but if, on the coiitr.irv. the voice is used 
carefully it may last for several months. 

The treatment of laryngitis as with the otlier forms of throat disease 
previously described, must be entirely of a local nature. The medicines 
used must be applied into the larynx itself through the agency of instru- 
ments especially designed for that purpose. There are three methods 
of making applications to the interior of the voice-box, namely: 

The compressed air spray method. 

The brush method, and finaly 

Insufflation. 

The spray treatment is essentially the same as that described when 
speaking of pharyngitis, with the single exception that the spray tube 
points downwards instead of forwards. The brusli method consists 
simply in the introduction of camel's hairbrushes attached to a long and 
curved handle into the interior of the laryngeal organ. Insufflation 
consists simply in the blowing into the larynx of medicated powders bv 
an instrument which is called an insufflater. 

Many singers have an idea that the direct application of medicines 
to the vocal apparatus is pi-oductive of great pain. This is a great 
mistake, for when the operation is performed by the skilled manipulator 
very little annoyance is occasioned and in some cases, particularly those 
of nasal catarrh, the treatment is rather agreeable than otherwise. Of 
course if a person who does not understand the throat attempts to treat 
it, much pain will result from his efforts Ji/sf, because of a lack of skill 
in handling the instrument, and second, on account of the medicines 
employed,, these persons generally using much too powerful remedies. 



CHAPTER V. 

PARALYSIS OF THE VOCAL CORDS. 

Paralysis of the vocal cords is by far the most interesting of all the 
types of laryngeal disease. In order to fully understand the description 
of the several paralytic affections to be shortly given, it will be abso- 



30 SINGERS' THROAT TROUHLES, 

lutely necessary to stop foV a moment and look into the pliysiological 
action of the vocal cords. As I have fully treated of this subject in my 
work entitled •' The Throat in Relation to singing," I shall merely give 
a brief synopsis here. Vocal sounds are produced by the vibration of 
the vocal cords, which action is caused by the passage of the air-current 
through the chink 'of the glottis, the opening between the two vocal 
cords. W'hat does this vibratory action on the part of the vocal bodies 
do ? Why it divides the current of air into a large number of little 
currents which are then known as tone-waves. These tone-waves 
passing up into the mouth are formed into articulate speech by the 
action of the tongue and other organs contained in the mouth. The 
vocal cords are merely two thin elastic bands of tissue running across 
the larynx from before backwards, attached firmly in front to the inside 
of the voice-box immediately behind the prominence known as the 
" apple," and behind to two bones which are called the arytenoid carti- 
liges. The vocal cords together with their points of attachment to the 
larynx are beautifully displayed in the subjoined cut. 




P'igure I. Horizontal section of the Laryn.x. 

I. Outer framework of larynx. 3. Arytenoid cartilages, the bones 
to which the vocal cords are attached behind. 5. Vocal cords. 7. The 
point of attachment of vocal cords in front. 

In this drawing the cords are represented as being oj^en as during 
inhalation ; when they are brought together the passage between them 
which is then called the chink of the glottis, may be represented by a 
single dark line. The bones to which the cords are attached behind 
the arytenoid cartilages, are of the greatest importance since it is mainly 
by their action that the cords perform those movements, so characteris- 
tic of them and upon which vocalization principally depends. Since the 
princijially movements of the vocal bodies are dependent upon the 
action of the arytenoids it follows of a necessity, the muscles which 
preside over the vocal movements, must be attached to these cartilages. 
This indeed is true with a single exception which shall be presently 
alluded to. When the cords are separated as during respiration and it 
is desired to use the voice these bodies are brought together. This 



Til KIR CAIJSK AND CUKK. 



31 



action is known as adduction and is produced as you may easily 
imagine by simply drawing together the twtj arytenoid cartilages. This 
action is performed by a muscle whicli rinis from one arytenoid to the 
other, and is attached to both bones, 'i his Ijody, winch is rlisj^Iayed in 
figure 2, is called, from the effect whif;h its acti(;n has on the vocal 
cords the adductor muscle, a derivation from two Latin words, ad and 
ducto^ meaning to lead to. 

I. Epiglottis, or guardsman of 
larynx ; 4. cricoid cartilage, the body 
on which the arytenoids revolve; 
5 arytenoid cartilages. T. transverse 
laryngeal muscle the adductor of the 
vocal cords P. abductor muscle or 
separator of vocal cords. 

Whenever it is necessary to take 
a breath during vocalization the cords 
must fly back or separate. This action 
is called abduction which term is a 
derivation from two Latin words ab 
and ducto meaning to lead from. This 
action is brought about through the 
agency of a single muscle, fig. 2. P.) 
which is attached as plainly shown 
in cut to the lower part of the ary- 
tenoid and the back of the cricoid 
cartilage. This muscle separates or 
abducts the cords by simply revolving the arytenoids outwards. In the 
above drawing the left muscle is only depicted, their being a similar 
muscular body on the opposide side. There are two other actions of 
the vocal cords, making four in all, which remain to be described, 
namely : tension and relaxation. 

TENSION is performed by a single muscular body called the ten- 
sor muscle. It is attached to the front of the voice box on the outside 
and tenses the cords by drawing the front of the larynx directly down- 
wards which increases the distance between the two points of attach- 
ment of the vocal cords in front and behind and stretches these banes. 

RELAXATION is performed by two muscles style the relaxors 
and which are attached to the same bones as the vocal cords. There 
is one of these muscular bodies for each vocal cord and they relax 
these bands by drawing together the two portions of the voice-box to 
which they are attached. 

PARALYTIC AFFECTIONS of the vocal cords may be most 
conveniently divided into four varieties, each one of which shall corres- 




Framework of the larynx seen 
from behind. 



32 



SINGERS' THROAT TROUHLKS, 



pond to one of the four movements desrribed above as characteristic ol 
the vocal bodies. 

These forms enumerated in their resi^eclive order are : 

1. Paralvsis of adduction. 

2. Paralysis of abduction. 

3. Paralysis of Tension. 

4. Paralysis of Relaxation. 

PAR.M>YSIS OF ADDUCTION is a lack of power in the ad- 
ductor muscles to draw together tlie arytenoids and thus adduct the 
cords. In this variety of paralysis which is shown below the vocal 
cords are permanently sejjarated from inahilit) on the part of the ad- 
ductor muscles to approximate them. 

a, a, the two arytenoids, h, back wall 
of larynx s, s, points of attachment of 
cords to arytenoids, c, opening between 
the cords, k, attachment of two cords to 
front of larynx. 

The annexed illustration, which is simply 
an outline drawing, will give a pretty good 
idea of this variety of laryngeal paralysis. 
When an attempt at vocalization is made 
the vocal cords instead of approximating 
or coming together, as they naturally would 
in a healthy larynx remain permanently 
fixed at the sides of the voice-box. Why ? 
because the transverse muscle (see fig. 2) 
which presides over abduction, being par- 
lyzed, is unable to perform its duty, namely, the drawing together of the 
arytenoids and with thcin the vocal cords. 

What will be the effect of this form of laryngeal disease upon the 
voice ? A complete loss thereof, both in speaking and singing ; 
because the cords not being able to come together there can be no 
vibration in them. This, which is the most prominent symptom of par- 
alysis of adduction, is called aphonia. The only other symptoms liable 
to manifest themselves in this affection are a slight cough and irritation 
due to a congestion of the parts. 

PARALYSIS OF ABDUCTION is simply an inability on the 
part of the abductor muscles or separators of the vocal cords, to 
abduct or separate these bodies. 

In this variety of paralysis the two cords remain jjermanently fixed 
in the middle of tiie larynix as shown in l''ig. 4. 




Paralysis of adduction of vocal 
cords. 



THEIR CAUSK AND CURK. 



33 




Paralysis of abduction 
of vocal cords. 



A. A. arytenoid cartilages ; I!. I'., paralyzed cords ; C. front wall of 
larynx; D, back wall of larynx. 

The cords occupy the above position because the adfluclor muscles, 
acting properly, bring together the cords, but the 
abductor muscles being inactive on account of 
paralysis are unable to bring the vocal bodies 
back to the sides of the larynx. The two sets of 
muscles, the abductors and the adductors, when 
healthy are antagonistic to each other, conse- 
quently when either set is paralyzed, there being 
no opposing forces brought to bear against the 
healthy set it acts continuously, thus when the 
abductors are paralyzed, the adductors keep the 
vocal bodies permanently united. 

The muscle involved in paralysis of abduction 
is depicted in fig. 2. (P). It, as we have seen, 
abducts the cords by revolving outward the 
arytenoid cartilages. In order that air shall pass through the larynx in 
its journey to the lungs, it is absolutely necessary that the vocal cords be 
widely apart. If this condition be not permitted and the cords are 
drawn close together, no matter how slight may be the degree of such 
approximation, the proper performance of respiration is interfered with. 
The most prominent symptom of this form of laryngeal paralysis is a 
great difficulty in breathing or dyspnoea as it is technically called. 
When the paralysis is complete, that is to say, wlien the cords are in 
direct opposition, the above interference to respiration is marked, and 
the occasion of the greatest suffering, all the air that enters the lungs 
having to pass through the narrow opening known as the chink of the 
glottis. The voice is not apt to be much interfered with, because the 
vibratory power of the cords is not destroyed, and because these bodies 
are approximated in the proper manner to produce tone. The difficulty 
of breathing above described comes on in spasms, as it Avere, during 
each of which the life of the sufferer is seemingly in great danger. Aftera 
Avhile inflammatory action is set up in the larynx which, on account of the 
accompanying swelling, greatly increases the suliterings of the patient. 
The above symptoms increase until finally, unless relief is afforded by 
surgical interference, the sufferer must die. Fortunately paralysis of 
abduction, as depicted above is an extremely rare affection, this disease 
being generally of a partial nature, and its symptoms therefore some- 
what modified. 

Upon inspecting the larynx in a severe case of paralysis of abduc- 
tion, the picture presented upon the laryngoscopic miiTor will be most 
striking. The vocal chords will be seen drawn together and lying almost 



34 



SIJJGERS' THROAT TROUBLES, 



motionless in the centre of the larynx, and the opening between these 
bodies, the chink of the glottis will be clearly defined and about a line 
in extent. The larynx will also be seen to be the seat of inflammatory 
action, the mucous membrane being quite red and somewhat swollen. 

PARALYSIS OF TENSION is an inability on the part of the 
tensor muscles to stretch the vocal cords. In this variety of laryngeal 
paralysis the vocal cords, when adducted. jn-csent a relaxed condition 
from a lack of action in the muscular body presiding over tension. Ad- 
duction and abduction are in no wMse interfered with, the vocal cords 
being approximated and separated in a perfectly normal manner. Upon 
laryngeal inspection the picture presented in this afteclion is somewhat 
like the subjoined cut. 

A A, arytenoids ; B B, relaxed cords ; C, front wall of the larynx ; 
D, back wall of larnyx ; E, ellipitical opening 
between cords. 

In order to thoroughly understand this form of 
laryngeal paralysis, as well as the variety next to be 
described, it will be necessary to glance for a mo- 
ment at the effect exerted upon the singing voice 
by the two vocal movements called tension and 
relaxation. When the two cords are brought to- 
gether by the phonatory act, a tone located about 
the middle of the vocal register can be rendered 
without much action on the tensor or relaxor mus- 
cles. If, however, a higher note be demanded, in 
order that the vocal bodies shall make the required 
number of vibrations they must be made tensor. 
This duty is performed by the tensor muscles, 
which bodies stretch the cords as we have already seen, by pulling the 
front part of the larynx downwards. The higher the note is placed in 
the scale the more will it be necessary to tense the cords. 

Now, supposing when the cords are brought together a lower instead 
of a higher note is required what then must transpire? Why the cords 
must be relaxed, for the reason that the number of vibrations necessary 
to produce a lower tone is less, and that in order to diminish the number 
of vibrations in any giving period of time, the aid of the relaxor muscles 
must be invoked. The lower the note the slower must be the vibrations, 
and consequently the greater must be the relaxation of the vocal bodies. 
When, therefore, the tensor muscle is paralyzed and unable to perform its 
function, that is the tightening of the vocal cords it will be impossible for 
the affected person to render, in any degree, the higher notes of the register. 

PARALYSIS OF RELAXATION is an inabihty on the part of 
the relaxor muscles to perform their function, namely the relaxation or 




THEIR ClAliSK ANF) CUKK. 



35 



loosening of the vocal cords. In lliis species of vocal paralysis, wliile 
the cords can be broiiglil to^rcther and separated in a perfectly normal 
manner it will be inip()ssil)lc to relax them. 'I'he relaxor muscles, which 
are called the vocal muscles par-excellence, relax the cords by drawing 
together the two points of attachment of the vocal corrls, which action 
of course loosens these bodies. In the above movement, the relaxor 
muscles are directly antagonistic to the tensor muscles. Now supposing 
from paralysis or other cause, the relaxor muscles are unable to relax or 
loosen the cords what will hap[)en ? Why the tensors having no oppos- 
ing forces to contend against will keep the cords in a perpetual state of 
tension. 

As you have undoubtedly already suspected the effect upon the 
voice by the variety of laryngeal paralysis under consideration will be an 
inability to render the lower notes of the register; because the vocal 
cords cannot be relaxed enough to allow of a sufficiently slow vibration 
for the production of these tones. I had, several years ago, a remarkable 
and instructive case of this form of laryngeal paralysis which I think will 
be interesting to the singer. 

Mr. H., aged about 35, consulted me October 16, 1879, at the sug- 
gestion of his vocal teacher, to obtain an opinion regarding a peculiar 
defect in his voice. Upon interrogation I learned the following history. 
About two years previous, after an attack of cold, Mr. H. noticed that 
in talking the tone of his voice had altogether changed; that while 
previous to his " taking cold " he could talk in the ordinary tones of an 
adult male, he was subsequently unable to lower his voice, but was 
compelled to speak in his upper register ; in other words, his voice was 
the fac-siml/e of a. hoy's prior to the change which occurs at about the 
age of fourteen. The singing voice was likewise similarly affected, it 
being impossible for him to render any of the notes above the middle 
register. Thinking that time would mitigate the difficulty, my patient 
pursued no course of treatment other than an attempt to regain his lost 
powers by vocalatory exercises. This latter procedure being entirely 
void of good result, he was induced to seek medical advice. At the 
time of seeing Mr H., the difficulty above described was so manifest 
that were I to have conversed with him a dark room I would most cer- 
tainly have pronounced him a boy of about twelve or thirteen. Upon 
laryngeal examination I found the larynx comparatively healthy, there 
being but a slight amount of congestion in the tissues adjacent to the 
cords. Upon requesting the patient to phonate I noticed that although 
adduction was performed perfectly, the vocal chords were both in a state 
of great tension — such a condition in fact as one would expect to find 
during the rendition of the higher notes of the register. Again and again 
I repeated the experiment, requesting the patient to render certain 
musical tones, with a similar result, each successive examination confirm- 



^6 SINGERS^ THROAT TROUBLES, 

ing its predecessor. The most ciiriovis circumstance connected with the 
whole case was the following: by pressmg on the front of the larynx in 
the neighborhood of Adam's apple, the voice suddenly assumed a 
natural cliaracter, drojjping from the tones of a boy to those of an adult 
male. As long as this pressure was kept up Mr. H. talked quite 
easily in what would naturally have been his voice, were not his larynx 
the seat of the paralysis of the relaxor muscles, but the moment the hand 
was removed from the throat, the voice assumed its former unnatural 
condition. The reason of the dropping of the voice when pressure was 
exerted on the voice-box, was that this action took the place of the 
paralyzed muscles and relaxed the cords by diminishing the distance 
between the points of attachment of the vocal bodies. The causes of 
the several forms of paralysis enumerated above are oftentimes involved 
in obscurity. Mental emotion will sometimes produce them ; instances 
of sudden loss of voice through fright being quite common. The variety 
of laryngeal paralysis described under the head of paralysis of ai^duction, 
and which is characterized by great interference with respiration, is gen- 
erally caused by pressure on the laryngeal nerve which thus interferes 
with or shuts oft" the nervous supply to the larynx. Overwork is a fre- 
quent cause of laryngeal paralysis in the vocalist. Many great singers 
have lost their voices at some time or another by this practice. The 
immense price sometimes paid to these artists stimulates them to sing 
through a long season and many times when they are utterly unfit to per- 
form. 1 know of several artists now very popular, who are doing too 
much vocal work, and which will end up by an entire destruction of their 
voices unless they take the much-needed rest. Since the reign of comic 
opera many have risen and fallen, and this will continue to be the case 
as long as the singer is compelled to vocalize six nights a week and two 
Biatinees. No artist who has a good voice should endanger it by such 
continuous action ; it is too much to expect of the delicate vocal cords, 
and it will assuredly tell upon them in the long run ; it is simply a matter 
of time. 

STRAIN OF THE VOICE is another frequent cause of vocal 
paralysis. This is often the result of vocalizing with the cords at too 
high a tension, or in other words attempting to sing entirely outside of 
the normal register. 

Some forms of vocal paralysis, especially that type described under 
the heading of paralysis of abduction, are exceedingly difficult to cure. 
Those varieties, however, which are so often found in the throats of 
singers, as a direct result of abuse of the voice, are amenable to treat- 
ment and oftentimes speedily cured. 

As in paralytic affections of other parts of the body, electricity forms 
the sheet anchor of hope in the treating of laryngeal paralysis. 



THEIR CAUSE AND fJURR. 



37 



The inetluxl of its .-ulmiiiistration is most iiniijiic, .-ukI simply f:f>ri- 
sists in the introduction into the huynx itself of wh;it is known as a 
larngeal electrode. 




Fig. 6. Instrument for the introduction of electricity into the 
larynx. 



This instrument is connected to an electric battery by means of a 
fine wire which is attached to the little ring on the under surface of the 
handle. When inserted into the air tube, the spring located on the 
upper surface of the handle is depressed, which allows the electricity to 
travel through the instrument and into the larynx. By this method of 
treatment the electric current is brought into direct contact with the 
paralyzed cords. This is a great improvement upon the old method of 
application, which simply consisted in the electrization of the outside of 
the throat through the agency of sponges. I have frequently seen cases 
of paralysis of the vocal cords subside after a few direct applications of 
the laryngeal electrode when persistent treatment externally with the 
electric sponges have failed to give any relief whatever. 

Dr. WHITFIELD WARD. 

208 West 25th Street. 



Singers' 
Throat Troubles 



T 



HEIR Lause and Lure 



BY 



AATHITFIELD ^A^ARD, A. M. M. D. 

Physician to the Metropolitan Throat Hospital ; author of 
" The Throat in Relation to Singing," etc. 



PUBLISHED BY 
THE GRAND CONSERVATORY OF MUSIC PUBLISHING CO. 

46 West 23d Street, New York 

1885 





Date Due 


































































































































' 


















f) 












h 



